494 U.S. 210 (1990)
In August 1976 Walter Harper was sentenced to prison for robbery and incarcerated at the Washington State Penitentiary, where he spent most of his time in the mental health unit and consented to antipsychotic medication.1
In 1980 Harper was paroled on the condition that he participate in psychiatric treatment, which he received at Harborview Medical Center and later at Western State Hospital under a civil commitment order.2 His parole was revoked in December 1981 after he assaulted two nurses at a hospital in Seattle.3
Upon his return to prison, respondent was sent to the Special Offender Center, a 144-bed correctional institute established by the Washington Department of Corrections to diagnose and treat convicted felons with serious mental disorders.4 At the Center, Harper was diagnosed with a manic-depressive disorder and initially consented to treatment, including antipsychotic drugs, but in November 1982 he refused further medication.5
The treating psychiatrist then invoked SOC Policy 600.30 to administer the drugs involuntarily after a committee hearing found that Harper suffered from a mental disorder and posed a likelihood of serious harm to others.6 Harper was involuntarily medicated for about one year beginning November 23, 1982, then transferred to the Washington State Reformatory in November 1983 where he took no medication and his condition deteriorated, prompting his retransfer to the Center and another involuntary medication approval.7
He continued receiving the drugs subject to periodic reviews until his transfer to the Washington State Penitentiary in June 1986.8 In February 1985 Harper filed suit in state court under 42 U.S.C. § 1983 against the State and individual defendants, alleging that the failure to provide a judicial hearing before involuntary administration of antipsychotic medication violated due process and other constitutional provisions.9
After a bench trial in March 1987 the trial court upheld the policy's procedures as satisfying due process, but the Washington Supreme Court reversed, holding that a judicial hearing with full adversarial protections and proof by clear, cogent, and convincing evidence was required.10 The United States Supreme Court granted certiorari in 1989 to review the constitutional questions presented by the state court's decision.11
Whether the case is moot because the State has ceased administering antipsychotic drugs to respondent against his will?12
A live case or controversy remains if there is a strong likelihood that the alleged injury will recur but for the lower court decision, even if the specific conduct has ceased.13
No. Harper continues to serve his sentence in the Washington state prison system and remains subject to transfer to the Special Offender Center at any time.14 Given his medical history of serious mental disorder and two prior transfers to the Center between 1982 and 1986, Center officials would likely seek to administer antipsychotic medications pursuant to Policy 600.30 absent the Washington Supreme Court holding.15
The case is not moot.
Whether respondent possesses a liberty interest under the Due Process Clause in avoiding the involuntary administration of antipsychotic drugs?16
A significant liberty interest exists under the Due Process Clause of the Fourteenth Amendment in avoiding the unwanted administration of antipsychotic drugs, which alter the chemical balance in the brain and can cause serious side effects.
Yes. The forcible injection of medication into a nonconsenting person's body represents a substantial interference with that person's liberty.17 Policy 600.30 creates a justifiable expectation that drugs will not be administered unless the inmate suffers from a mental disorder and is gravely disabled or dangerous, and the Due Process Clause confers no greater right than that recognized under state law.18
Harper possesses a protected liberty interest.
Related opinions on this issue
The difficult and controversial character of this case is illustrated by the simple fact that the American Psychiatric Association and the American Psychological Association, which are respected, knowledgeable, and informed professional organizations, and which are here as amici curiae, pull the Court in opposite directions.19 I add a caveat. Much of the difficulty will be lessened if, in any appropriate case, the mentally ill patient is formally committed.
This on occasion may seem to be a bother or a nuisance, but it is a move that would be protective for all concerned, the inmate, the institution, its staff, the physician, and the State itself. It is a step that should not be avoided or neglected when significant indications of incompetency are present.20
Joined by Justices Brennan And Marshall
The Court has undervalued respondent's liberty interest; has misread the Washington involuntary medication Policy and misapplied our decision in Turner v. Safley; and has concluded that a mock trial before an institutionally biased tribunal constitutes due process of law.21 The liberty of citizens to resist the administration of mind altering drugs arises from our Nation's most basic values.22 The makers of our Constitution undertook to secure conditions favorable to the pursuit of happiness.
They recognized the significance of man's spiritual nature, of his feelings and of his intellect. They knew that only a part of the pain, pleasure and satisfactions of life are to be found in material things. They sought to protect Americans in their beliefs, their thoughts, their emotions and their sensations.
They conferred, as against the Government, the right to be let alone—the most comprehensive of rights and the right most valued by civilized men.
Whether the substantive standards of SOC Policy 600.30 for involuntary medication satisfy the requirements of the Due Process Clause?23
A prison regulation claimed to infringe on an inmate's constitutional rights is valid if it is reasonably related to legitimate penological interests under the Turner standard, even when the right is fundamental.
Yes. There is a valid, rational connection between Policy 600.30 and the legitimate governmental interest in prison safety and security.24 The policy applies only to inmates who are mentally ill and as a result gravely disabled or dangerous, requires prescription and approval by a psychiatrist, and serves the State's obligation to provide medical treatment consistent with both the prisoner's medical interests and institutional needs.25 Physical restraints are effective only in the short term, and can have serious physical side effects when used on a resisting inmate, as well as leaving the staff at risk of injury while putting the restraints on or tending to the inmate who is in them.
Furthermore, respondent has failed to demonstrate that physical restraints or seclusion are acceptable substitutes for antipsychotic drugs, in terms of either their medical effectiveness or their toll on limited prison resources.
The substantive standards satisfy due process.
Related opinions on this issue
Joined by Justices Brennan And Marshall
The Court misreads Policy 600.30 and misapplies Turner v. Safley. The policy permits forced medication based purely on the impact the disorder has on prison security without requiring a determination that medication advances the inmate's medical interest.26 By focusing on risk to people or property, the policy allows the State to override the prisoner's liberty interest for institutional concerns, resulting in an exaggerated response that eviscerates the substantive liberty interest.27
The State advances security concerns as a justification for forced medication in two distinct circumstances. A SOC Policy provision not at issue in this case permits 72 hours of involuntary medication on an emergency basis when an inmate is suffering from a mental disorder and as a result of that disorder presents an imminent likelihood of serious harm to himself or others.28 In contrast to the imminent danger of injury that triggers the emergency medication provisions, a general risk of illness-induced injury or property damage—evidenced by no more than past behavior—allows long-term, involuntary medication of an inmate with psychotropic drugs under Policy 600.30. This ongoing interest in security and management is a penological concern of a constitutionally distinct magnitude from the necessity of responding to emergencies.
Whether the Due Process Clause requires a judicial hearing before the State may administer antipsychotic drugs to a mentally ill prisoner against his will?29
The procedural protections required by the Due Process Clause are determined by reference to the private interests at stake, the governmental interests involved, and the value of procedural requirements under Mathews v. Eldridge; due process does not require a judicial decisionmaker when medical professionals can provide fair review under adequate procedures.
No. The administrative hearing procedures set by Policy 600.30 comport with procedural due process. The decisionmaker is a committee of a psychiatrist, psychologist, and associate superintendent none of whom may be involved in the inmate's current treatment or diagnosis, with rights to notice, attendance, presentation of evidence, cross-examination, lay adviser assistance, appeal to the superintendent, and judicial review by personal restraint petition.30 Independence of the decisionmaker is satisfied, periodic review occurs, and a judicial hearing would divert scarce prison resources without being more effective than administrative review by medical professionals.31
A judicial hearing is not required.
Related opinions on this issue
Joined by Justices Brennan And Marshall
The procedures of Policy 600.30 are constitutionally deficient because any decision approving psychotropic drugs must be made by an impartial professional concerned only with the individual's best interests.32 The critical defect is the failure to have the treatment decision made or reviewed by an impartial person or tribunal.33 The panel members have disqualifying conflicts of interest as colleagues of treating physicians and as regular staff concerned with institutional control, and the structure ensures the decision will not reflect independent professional judgment.34
These decisionmakers have two disqualifying conflicts of interest. First, the panel members must review the work of treating physicians who are their colleagues and who, in turn, regularly review their decisions. Such an in-house system pits the interests of an inmate who objects to forced medication against the judgment not only of his doctor, but often his doctor's colleagues.35
Second, the panel members, as regular staff of the Center, must be concerned not only with the inmate's best medical interests, but also with the most convenient means of controlling the mentally disturbed inmate.36